Remote Policy Governance Specialist — Medicaid UM & Reporting

Humana Inc; Atlanta (GA); Remote; USD 65,000 - 89,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Policy Governance Professional to oversee the Medicaid UM Rates and Timeliness reporting across markets, coordinating data validation, stakeholder collaboration, and documentation for compliance and quality improvement.

You will work with operational, clinical, quality, and governance teams, prepare committee materials, and ensure audit-ready records. Remote US nationwide with occasional travel; 40 hours weekly; base pay range is $65,000 to $88,600, with incentive

Qualifications

• Experience in healthcare operations, utilization management, quality, or governance.
• Proficiency with Excel, PowerPoint, Word, SharePoint, and related collaboration or tracking tools.

Responsibilities

• Own and coordinate end-to-end NCQA UM Rates and Timeliness reporting across applicable Medicaid markets.
• Manage reporting calendars, milestones, data collection, validation, approvals, and final deliverables.
• Collaborate with operational, analytical, clinical, quality, compliance, accreditation, and market teams to resolve data issues and report risks.
• Analyze results to identify trends, outliers, performance concerns, and opportunities for improvement.
• Coordinate, document, and monitor corrective actions, escalating overdue or high-risk items.
• Prepare reporting summaries and materials for review by UM Committees, leadership, and governance bodies.
• Maintain audit-ready documentation supporting reporting results, decisions, approvals, and committee oversight.
• Support broader Policy Governance activities, including policy lifecycle processes and regulatory alignment.

Skills

Healthcare experience

Data analysis

Cross-functional collaboration

Education

Bachelor’s degree

Tools

Excel

PowerPoint

Word

SharePoint

Job description

Humana Inc. is seeking a Policy Governance Professional to oversee the Medicaid UM Rates and Timeliness reporting across markets, coordinating data validation, stakeholder collaboration, and documentation for compliance and quality improvement.

You will work with operational, clinical, quality, and governance teams, prepare committee materials, and ensure audit-ready records. Remote US nationwide with occasional travel; 40 hours weekly; base pay range is $65,000 to $88,600, with incentive